		<form id="addpaymentform5">
		Unit: <br /><input type="text" id="unit" name="unit" value="<?php echo $_REQUEST['unit']; ?>"/><br />
		Amount: <br /><input type="text" id="amount" name="amount" /><br />
		Mode of Payment:<br /> 
		<select id="mode" name="mode">
			<option>Cash</option>
			<option>Check</option>
			<option>Bank Deposit</option>
		</select><br />
		Date Received: <br /><input type="text" id="date_received" name="date_received"/><br />
			 <script type="text/javascript">
			 <?php
$today = getdate();
?>

			$(function() {
			$("#date_received").datepicker({ dateFormat: 'yy-mm-dd'  });
			});
			</script>
		Receipt Number (if applicable): <input type="text" id="receipt_no" name="receipt_no"/><br /><br />
		<input type="submit" onclick="if($('#addpaymentform5').valid()){sendPayment()}" value="Add Payment" />
		</form>